tailieunhanh - Trauma Resuscitation - part 2

Với cuộc khảo sát chính, một nỗ lực phối hợp nhóm nghiên cứu là cần thiết. Thủ tục của các thành viên trong nhóm cá nhân theo sau theo một giao thức chính xác và nhiệm vụ được thực hiện cùng một lúc thay vì tuần tự. | RESUSCITATION AND STABILIZATION OF THE SEVERELY INJURED PATIENT 13 Figure Pulling the arms down for a cervical radiograph As with the primary survey a well-coordinated team effort is required. Procedures by individual team members are followed according to a precise protocol and tasks are performed simultaneously rather than sequentially. The common error of being distracted before the whole body has been inspected must be avoided as potentially serious injuries can be missed especially in the unconscious patient. During the secondary survey the airway nurse maintains verbal contact with the patient while the recording nurse continues to measure the vital signs regularly and monitors fluid balance. Unless already obtained in the primary survey all blunt trauma victims should now have a chest pelvis and lateral cervical spine x-ray performed. Providing all seven cervical vertebrae as well as the C7-T1 junction can be seen on the x-ray up to 85 of cervical spine abnormalities will be shown. The easiest way of ensuring an adequate film is obtained on the first attempt is for one of the team members to pull the patient s arms towards their feet as the radiograph is taken Figure to remove the shoulders from the x-ray field. Alternative views . oblique and Swimmer s view or investigations . computerized tomography CT can be used if this fails to give an adequate view. Further cervical spine views will be required before all injuries to the cervical spine can be excluded. Neurological state This comprises of an assessment of the conscious level using the Glasgow Coma Scale GCS the pupillary response and the presence of any lateralizing signs see Section . One of the circulation nurses should then continue to monitor these parameters. If there is any deterioration hypoxia or hypovolaemia must be ruled out before an intracranial injury is considered. Examination of the peripheral nervous system should be performed. Abnormalities of motor and sensory .